MON-521 GLP-1 Receptor Agonists and Risk for Dialysis, Cardiovascular Disease and Mortality in Patients with Type 2 Diabetes Mellitus and End Stage Renal Disease

Abstract Disclosure: A. Dharia: None. D. Desai: None. Introduction: Diabetes Mellitus is the leading cause of End-Stage Renal Disease (ESRD) worldwide, responsible for 44% of all new ESRD cases . Patients with both ESRD and Type 2 Diabetes Mellitus (T2DM) face significantly increased risks of cardiovascular disease, electrolyte imbalances, infections, dialysis, and mortality. Given the growing burden of these complications, this study aims to assess the impact of Glucagon-Like Peptide-1 (GLP-1) receptor agonists on dialysis initiation, cardiovascular outcomes, mortality, and hospitalizations in patients with T2DM and ESRD. While GLP-1 receptor agonists have demonstrated potential benefits in cardiovascular health, glycemic control, and weight management, their long-term effects on kidney function and the progression to dialysis remain unclear. Results: This retrospective cohort study analyzed data from the Trinitex database spanning from January 2013 to December 2022. The primary cohort consisted of 2,015 patients with T2DM and ESRD who had received GLP-1 receptor agonist therapy for at least 6 months. The control group included 200,774 patients who had not been on GLP-1 receptor agonist therapy for at least 6 months. A 1:1 matching process was applied to balance the two groups, resulting in 2,009 pairs for analysis. Key outcomes measured included dialysis, heart failure, acute myocardial infarction (AMI), acute kidney injury (AKI), all-cause mortality and hospitalization. Dialysis dependence was notably lower in the patients receiving GLP-1 receptor agonists (17.92% vs. 31.51%, OR 0.475, CI 0.409-0.55, p < 0.0001). There was decreased incidence of heart failure (4.98% vs. 15.63%, OR 0.283, CI 0.224-0.357, p < 0.0001), as well as AMI (1.74% vs. 3.83%, OR 0.445, CI 0.297-0.667, p < 0.0001). The rate of AKI was lower in the patients receiving GLP-1 receptor agonists (10.45% vs. 14.04%, OR 0.715, CI 0.591-0.865, p = 0.0005). Furthermore, all-cause mortality was significantly lower in the GLP-1 receptor agonist group (0.85% vs. 4.63%, OR 0.176, CI 0.104-0.296, p < 0.0001) along with the incidence of all-cause hospitalization (15.53% vs. 25.04%, OR 0.55, CI 0.47-0.644, p < 0.0001). Conclusion: In patients with type 2 diabetes and ESRD, GLP-1 receptor agonists have shown significant benefits, including reduced dialysis dependence, heart failure, acute myocardial infarction, acute kidney injury, and improved survival outcomes. These effects are driven by both direct renal mechanisms—such as enhancing natriuresis, reducing oxidative stress, and inflammation and improving glomerular hemodynamics—and indirect benefits, including better glucose control, lower blood pressure, and weight loss. Early initiation of GLP-1 therapy may offer substantial advantages in managing ESRD and diabetic kidney disease, ultimately improving long-term outcomes. Presentation: Monday, July 14, 2025